UNAIDS 95-95-95 Targets: Progress in HIV Testing (The First 95) as an HIV Prevention Approach Among Orphaned and Vulnerable Children (OVC) in Namibia

Abstract

Background: Since the onset of the HIV epidemic, over 40 million individuals have died from AIDS-related illnesses, leading to nearly 14 million children aged 0–17 losing one or both parents to AIDS by 2022. In 2023, Namibia had 250,000 vulnerable children and 72,000 children aged 0–17 orphaned due to HIV and AIDS. Without parental support, orphaned and vulnerable children (OVC) face heightened risks, including neglect, distress, and compromised decision-making. These vulnerabilities can increase their susceptibility to risky behaviors, such as sexual experimentation. This study used data from the Project HOPE Namibia (PHN) OVC program to assess HIV testing rates and associated factors among OVC. Methods: This retrospective cross-sectional secondary analysis study used data from PHN’s OVC program implemented from 1 August 2023 to 30 November 2024. Data were analyzed using Chi-square tests and binomial and multinomial logistic regression. Results: Among the 16,995 participants included in this analysis, 15,014 (88.3%) participants had ever been tested for HIV (95% confidence interval (CI): 87.8–88.8%). Participants with an increased likelihood of having ever tested for HIV included those who had been in the program for 0–6 months (adjusted odds ratio (AOR) = 1.31, 95% CI (1.17–1.47)), and those from households experiencing little or moderate hunger (AOR = 1.29, 95% CI (1.12–1.50), AOR = 1.51, 95% CI (1.33–1.72), respectively. Conclusions: A multi-pronged approach involving all stakeholders is required to increase HIV testing among OVC. Such an approach should include community-based HIV testing, providing male-friendly healthcare services, and reducing household hunger through economically empowering vulnerable households.

1. Introduction

Since 1981, AIDS-related illnesses have claimed over 40 million people worldwide [1]. In 2022, nearly 14 million children aged 0–17 lost one or both parents due to AIDS [2]. In 2023, Namibia had 250,000 vulnerable children and 72,000 children aged 0–17 orphaned due to HIV and AIDS [3]. Parental death constitutes a traumatic event that results in alterations to household structure and the child’s care environment, which may include the introduction of new caregivers [4]. The reduction in parental income sources heightens financial pressure on households, rendering essential expenses for food, health, and education unaffordable [5]. Without parental support and psychosocial care, orphaned and vulnerable children (OVC) face heightened risks, including neglect, distress, and compromised decision-making. These vulnerabilities can increase their susceptibility to risky behaviors, such as sexual experimentation, further emphasizing the need for targeted HIV prevention and testing initiatives [6]. Due to financial instability and food insecurity, OVC often face challenges in achieving optimal educational outcomes [7]. Additionally, the loss of parental support contributes to mental health issues such as depression and emotional distress [8]. These factors increase their vulnerability to risky behaviors, including early sexual debut, unprotected sex, and sexual coercion [6].

The United Nations aims to eliminate the HIV/AIDS epidemic as a public health threat by the year 2030. To achieve this goal, 95% of people living with HIV (PWH) must be aware of their HIV status, 95% must be receiving lifesaving antiretroviral therapy (ART), and 95% of those on ART must achieve viral suppression [1]. Despite advancements in addressing the global impact of HIV and AIDS, approximately 1.3 million people acquired HIV worldwide in 2023, reflecting a 60% reduction from the peak incidence in 1995 [9]. However, current infection rates significantly exceed the UNAIDS target of 370,000 by 2025 [9]. Adolescents and young adults, particularly OVC in sub-Saharan Africa (SSA), are disproportionately affected. In 2023, there were 120,000 new HIV infections among children aged 0–14 years [9]. Another concern is that while 86% of PWH globally were aware of their HIV status in 2023, only 66% of children aged 0–14 years knew their HIV status [9]. While a high HIV-positive status has been reported among OVC [10], many of them may be unaware of their HIV status because of several barriers they face when trying to access HIV testing services (HTS). Barriers to HTS among OVC include insufficient youth-friendly services, negative attitudes among healthcare workers, fear of stigmatization and discrimination, and inadequate financial resources for travel to healthcare facilities [11,12]. HIV testing serves as a crucial initial measure for primary prevention and the treatment of OVC who are HIV-positive. OVC who are unaware of their HIV status and who are HIV-positive are unlikely to engage in HIV care, resulting in adverse health outcomes. Awareness of one’s HIV status can promote safer sexual practices, potentially decreasing new HIV infections and aiding in the control of the HIV epidemic [11].

Although HIV testing among Namibia’s general population has been studied extensively [13,14], research specifically addressing HIV testing rates and associated factors among OVC remains limited. This study used data from the PHN-implemented OVC program to evaluate HIV testing rates and associated factors among OVC. The findings from this study aim to inform evidence-based policies and programmatic strategies that enhance HIV testing uptake among OVC, ultimately contributing to Namibia’s broader efforts to achieve the UNAIDS 95-95-95 targets.

2. Materials and Methods

2.1. Study Design

This study is a retrospective cross-sectional secondary analysis of programmatic data collected from OVC participating in the PHN OVC program from 1 August 2023 to 30 November 2024.

2.2. Program Sites

The program was implemented in 13 districts in six regions of the country. Apart from the capital city, Windhoek, located in the Khomas region, all the other districts were selected from regions with high HIV prevalence and incidence among adults, and where PHN was already implementing different projects. The regions with high HIV prevalence are heavily affected by poverty, high mobility, and widespread transactional sex driven by food insecurity [15,16]. More details on the regional differences in HIV prevalence and incidence in Namibia among PWH aged 15 to 49 years are presented in

Table 1. Regional HIV Prevalence, Incidence, and Program Districts.

Region	HIV Prevalence (%)	HIV Incidence (%)	Program District
Kunene	6.6	0.2	–
Omaheke	6.8	0.24	–
Khomas	7.8	0.18	Windhoek
Karas	8.9	0.2	–
Erongo	9.2	0.2	–
Hardap	9.4	0.3	–
Otjozondjupa	9.5	0.28	–
Ohangwena	12.8	0.56	Eenhana, Engela, Okongo
Omusati	13.2	0.48	Okahao, Oshikuku, Outapi, Tsandi
Oshana	13.3	0.42	Oshakati
Kavango West	13.6	0.6	–
Kavango East	13.7	0.58	–
Oshikoto	16.1	0.80	Omuthiya, Onandjokwe, Tsumeb
Zambezi	20.4	0.78	Katima

Source: National Strategic Framework for HIV and AIDS Response in Namibia 2023/24 to 2027/28 [17]. En-dash (–): No districts were chosen for the program in that region.

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2.3. Program Intervention and Population

The PHN-implemented OVC program defined OVC as children who were affected by HIV and AIDS due to their own or their caregivers’ HIV status or other socioeconomic vulnerabilities. The OVC program served as a critical intervention designed to enhance the well-being of children impacted by HIV, violence, poverty, and various other vulnerabilities. The program used a structured case management system to identify, assess, and address beneficiaries’ needs, facilitating their advancement toward independence and graduation from program support. The program was designed for individuals aged 0 to 17 years. Program participation was also open to those aged 18 and 19 who were still in secondary school or enrolled in an economic strengthening intervention by the time they turned 18. Children prioritized for support included those living with HIV, survivors of violence, particularly sexual violence, children from child-headed households, children with parents or caregivers who are HIV-positive, children of female sex workers, and infants exposed to HIV. Beneficiaries underwent assessment at least twice a year, utilizing standardized instruments. The assessment encompassed critical domains, including health, education, economic stability, safety, and psychosocial well-being. Case plans were formulated according to assessment results. Plans emphasized the need to address critical vulnerabilities, including inadequate school attendance, food insecurity, exposure to violence, and unmet health needs. Benchmarks for improvement and graduation goals were clearly established. Services offered encompassed health care linkage, educational support, economic strengthening interventions, psychosocial support, and gender-based violence prevention services. Upon enrolment, beneficiaries underwent an assessment for HIV risk and were subsequently connected to HTS. Beneficiaries testing positive for HIV were linked to ART, received information on HIV treatment, were counseled regarding HIV disclosure, obtained adherence support, and were linked to support groups. PHN-implemented OVC program aligned with the Namibian National Strategic Framework (NSF) 2023/24–2027/28 [17] by implementing community-based approaches to case finding, linkage to care, and household (HH) support for adherence and viral load (VL) monitoring. The focus remained on age-specific, need-responsive interventions to ensure optimal HIV care and treatment outcomes.

2.4. Data Source

Anonymized data were obtained from the PHN OVC program database. The source document was PHN’s child case management booklet. The data gathered during the program included programmatic details, participants’ sociodemographic characteristics, HIV risk factors, vulnerability factors, and outcomes related to the HIV cascade.

2.5. Outcome Variable

The dependent variable in this study was “Ever been tested for HIV?” The answers to this question were ‘Yes’ or ‘No’. ‘Yes’ was assigned code ‘2’, whereas ‘No’ was assigned code ‘1.’ Verbal confirmation of or documented HIV test results were both considered ‘Yes.’

2.6. Explanatory Variables

This study used fourteen explanatory variables, grouped into participants’ characteristics, vulnerability, and HIV risk factors. Several studies have reported the relevance and significance of vulnerability and HIV risk factors to HIV testing among OVC [18,19].

2.7. Participant Characteristics

Participants’ characteristics included age, sex, district, educational enrolment status, and the number of months in the program. Age, collected as a discrete numerical variable during the program, was categorized into age groups ‘0–9,’ ‘10–14’, and ‘15–19’. Sex was classified as ‘male’ and ‘female’, while educational enrolment status was categorized as ‘Never enrolled’, ‘Enrolled’, and ‘Dropout’. The number of months in the program was classified as ‘0–6 months’ or ‘7–12 months’.

2.8. Vulnerability and HIV Risk Factors

The vulnerability factors examined in this study included household hunger, the living status of biological parents, whether the child resided in a child-headed household, disability status, whether parents or caregivers had a source of income, and tuberculosis (TB) diagnosis status. The HIV risk factors included sexual abuse, sexual exploitation, and whether the participants ever had sex. All the responses were coded as ‘yes’ or ‘no’, except for the living status of biological parents, which was categorized into ‘One parent alive’, ‘Both parents alive,’ and ‘Both parents dead’.

2.9. Data Quality Assurance

The digital system facilitated the automatic generation of BioID (Unique Identifier Code), implemented automated skip rules, and conducted validation checks for variables such as age and sex, as well as constraints for mandatory questions. The digital system minimized transcription errors, thereby improving data completeness and quality. Data quality assurance (DQA) mechanisms included periodic programmatic spot checks, desk reviews, data quality reviews, and field monitoring by district and regional teams to ensure that reported data met minimum quality standards.

2.10. Criteria for Inclusion in Data Analysis

From the 19,121 individuals newly recruited into the program between 1 August 2023, and 30 November 2024, we excluded 2126 individuals with incomplete responses to the selected variables. The data analysis comprised 16,995 participants.

2.11. Data Analysis

Data were exported from DHIS2 to IBM SPSS version 29 for subsequent analysis. Descriptive statistics, including percentages and frequencies, were utilized to analyze nominal and ordinal data. Chi-square tests assessed the relationships between HIV testing history and the participants’ characteristics, vulnerabilities, and risk factors for HIV. We analyzed statistically significant characteristics identified via Chi-square tests using bivariate logistic regression to assess their associations with HIV testing history. Characteristics showing statistically significant associations with ever testing for HIV (p-values < 0.05 in binomial logistic regression) were included in a multinomial logistic regression to estimate adjusted odds ratios.

2.12. Ethical Considerations

Reach Namibia, implemented by PHN, has been approved by the Namibian Ministry of Health and Social Services (MHSS), the Ministry of Education, Arts, and Culture (MoEAC), the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW), and the Ministry of Sport, Youth and National Service (MSYNS). Enrollment into the OVC program was entirely voluntary. All minors in the program provided assent, and their parents or caregivers granted consent. OVC of legal age completed a consent form. Data were collected only from participants after they had given informed consent. PHN implements a comprehensive privacy management framework by requiring all personnel to sign a Non-Disclosure Agreement and to safeguard all collected data. Access to DHIS2 was granted based on defined roles and criteria. Each user was assigned a unique username and password-protected login credentials. De-identified or aggregated data were employed when data sharing was necessary. Approval from an institutional review board was not required for the secondary data analysis, as anonymous programmatic data was utilized.

3. Results

3.1. Characteristics of Participants

Among the 16,995 participants included in this analysis, most were female (n = 8949; 53.8%), aged 0–9 years (n = 9567; 56.3%), in the OVC program for six months or fewer (n = 10,972; 64.6%), and enrolled students (n = 10,284; 60.5%). More details are in

Table 2. Frequency distribution of characteristics of participants.

Characteristics	Frequency n (%)
Age group (years)
0–9	9567 (56.3)
10–14	4214 (24.8)
15–19	3214 (18.9)
Months in the program
0–6	10,972 (64.6)
7–12	6023 (35.4)
Educational enrolment status
Never enrolled	6323 (37.2)
Dropout	388 (2.3)
Enrolled	10,284 (60.5)
Sex
Male	7846 (46.2)
Female	9149 (53.8)
District
Eenhana	2351 (13.8)
Engela	4120 (24.2)
Katima	2460 (14.5)
Okahao	300 (1.8)
Okongo	607 (3.6)
Omuthiya	484 (2.8)
Onandjokwe	1726 (10.2)
Oshakati	2098 (12.3)
Oshikuku	628 (3.7)
Outapi	570 (3.4)
Tsandi	319 (1.9)
Tsumeb	476 (2.8)
Windhoek	856 (5.0)

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3.2. Vulnerability and HIV Risk Factors Among Participants

The most common sources of vulnerability among the participants were having parents or caregivers without a source of income (n = 6193; 36.4%) and experiencing severe hunger (n = 3517; 20.7%). Other sources of vulnerability included disability (n = 350; 2.1%), having both parents dead (n = 315; 1.9%), and living in child-headed households (n = 58; 0.3%). Few participants reported ever having sex (n = 229; 1.3%), ever being sexually abused (n = 66; 0.4%), and ever being sexually exploited (n = 19; 0.1%). More details are in

Table 3. Frequency distribution of vulnerability and HIV risk factors among participants.

Characteristics	Frequency n (%)
Household hunger scale
Little or no hunger	4981 (29.3)
Moderate hunger	8497 (50.0)
Severe hunger	3517 (20.7)
Are your parents alive?
Both parents alive	14,230 (83.7)
One parent alive	1659 (9.8)
Both parents dead	315 (1.9)
Don’t know	222 (1.3)
Missing	569 (3.3)
Is the child living in a household headed by a child?
Yes	58 (0.3)
No	12,259 (72.1)
Missing	4658 (27.4)
Do you have any disability?
Yes	350 (2.1)
No	15,717 (92.5)
Missing	928 (5.5)
Does the parent/caregiver have a source of income?
Yes	9927 (58.4)
No	6193 (36.4)
Missing	875 (5.1)
Have you ever been sexually abused?
Yes	66 (0.4)
No	12,267 (72.2)
Don’t know	16 (0.1)
Missing	4646 (27.3)
Have you ever been sexually exploited?
Yes	19 (0.1)
No	12,254 (72.1)
Don’t know	17 (0.1)
Missing	4705 (27.7)
Have you ever had sex?
Yes	229 (1.3)
No	7362 (43.3)
Missing	9404 (55.4)
Is the child a presumptive or diagnosed TB case?
Yes	94 (0.6)
No	12,043 (70.9)
Don’t know	39 (0.2)
Missing	4819 (28.4)

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3.3. HIV Testing Rate

Among the 16,995 participants included in this analysis, 15,014 (88.3%) participants had been tested for HIV before, with a 95% confidence interval (CI) (87.8–88.8%), while 1981 (11.7%) had never been tested before, 95% CI (11.2–12.2%).

3.4. Model Fitness Statistics

The model fitness statistics revealed that the multinomial logistic regression model was statistically significant compared to the Null model (p < 0.001). Nagelkerke R² is 0.376, indicating that only 37.6% of the variation in HIV testing is accounted for by the independent variables in the model. More details are in

Table 4. Model Fitness Statistics.

Omnibus Tests of Model Coefficients
		Chi-Square	Degrees of Freedom (df)	Sig.
Step 1	Step	517.591	29	<0.001
	Block	517.591	29	<0.001
	Model	517.591	29	<0.001
Model Summary
Step		−2Log likelihood	Cox & Snell R Square	Nagelkerke R Square
1		9441.818	0.244	0.376

Bolded numbers mean the results are statistically significant.

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3.5. Determinants of HIV Testing Among Participants

Chi-square tests revealed statistically significant associations between ever testing for HIV and the age group, educational enrolment status, sex, district, and months in the program (p < 0.05). Furthermore, Chi-square tests also revealed a significant association between ever testing for HIV and household hunger and whether the child was diagnosed or presumed to have tuberculosis (TB) (p < 0.05). However, disability, source of income status of parent or caregiver, sexual abuse, sexual exploitation, and the presence of biological parents were not significantly associated with ever testing for HIV. Participants who were in the program for 0–6 months and those who were diagnosed or presumed to be having TB were more likely to have ever been tested for HIV, with adjusted odds ratios (AOR) = 1.31, 95% CI (1.17–1.47), and AOR = 1.40, 95% CI (1.29–1.74), respectively. Participants in Eenhana, Okongo, Omuthiya, Onandjokwe, Oshikuku, Tsandi, and Tsumeb had a higher likelihood of reporting ever being tested for HIV than those in Windhoek. Participants from households with little or no hunger and with moderate hunger were more likely to report having ever been tested for HIV, adjusted odds ratio (AOR) = 1.29, 95% CI (1.12–1.50), AOR = 1.51, 95% CI (1.33–1.72), respectively. In contrast, males were less likely ever to have been tested for HIV than females, adjusted odds ratio (AOR) = 0.89, 95% CI (0.81–0.99). More details are in

Table 5. Determinants of HIV testing among participants.

Characteristics	Crude Odds Ratios	95% CI *	Adjusted ** Odds Ratios	95% CI *	Chi-Square Test p-Value
Age group (years)					<0.01
0–9	1.30	1.10–1.53	1.18	0.97–1.43
10–14	1.06	0.88–1.28	1.04	0.85–1.26
15–19	Reference	Reference	Reference	Reference
Months in the program					<0.01
0–6	1.31	1.18–1.45	1.31	1.17–1.47
7–12	Reference	Reference	Reference	Reference
Educational enrolment status					<0.01
Never enrolled	1.26	1.13–1.39	1.25	1.10–1.43
Dropout	1.12	0.67–1.86	1.21	0.71–2.04
Enrolled	Reference	Reference	Reference	Reference
Sex					0.04
Male	0.90	0.81–0.98	0.89	0.81–0.99
Female	Reference	Reference	Reference	Reference
District					<0.01
Eenhana	2.48	1.93–3.20	2.17	1.67–2.81
Engela	1.16	0.93–1.45	0.91	0.72–1.14
Katima	1.22	0.96–1.56	1.03	0.80–1.32
Okahao	0.96	0.61–1.51	0.89	0.56–1.41
Okongo	38.77	12.24–122.82	32.76	10.32–104.01
Omuthiya	6.61	3.17–13.78	4.56	2.18–9.55
Onandjokwe	1.41	1.09–1.81	1.35	1.04–1.75
Oshakati	0.97	0.76–1.22	0.82	0.64–1.04
Oshikuku	4.45	2.46–8.07	3.77	2.07–6.87
Outapi	1.33	0.90–1.96	1.13	0.76–1.68
Tsandi	2.84	1.52–5.31	2.34	1.25–4.40
Tsumeb	1.76	1.23–2.52	1.60	1.11–2.29
Windhoek	Reference	Reference	Reference	Reference
Household hunger					<0.01
Little or no hunger	1.36	1.18–1.56	1.29	1.12–1.50
Moderate hunger	1.57	1.39–1.77	1.51	1.33–1.72
Severe hunger	Reference	Reference	Reference	Reference
Are your biological parents alive?					0.33
One parent alive	NC	NC	NI	NI
Both parents alive	NC	NC	NI	NI
Both parents dead	NC	NC	NI	NI
Is the child living in a household headed by a child?					0.56
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Do you have any disability?					0.06
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Does the parent/caregiver have a source of income?					0.09
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Have you ever been sexually abused?					0.92
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Have you ever been sexually exploited?					0.31
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Have you ever had sex?					0.71
Yes	NC	NC	NI	NI
No	NC	NC	NI	NI
Is the child a presumptive or diagnosed TB case?					<0.01
Yes	1.58	1.05–1.90	1.40	1.29–1.74
No	Reference	Reference	Reference	Reference

NC—Not computed; NI—Not included; * CI is the 95% confidence interval; ** Adjusted for district, number of months in the programs, age group, sex, household hunger scale, educational enrolment status, and TB diagnosis; Bolded numbers mean the results are statistically significant.

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4. Discussion

This study revealed that 88.3% of the participants had ever been tested for HIV. Participants having a higher likelihood of having ever tested for HIV were those 0–9 years old, 0–6 months in the program, and from households with little or no hunger and moderate hunger. Furthermore, participants who never enrolled in school and those from Eenhana, Okongo, Omuthiya, Onandjokwe, Oshikuku, Tsandi, and Tsumeb were more likely to have ever been tested for HIV. In contrast, males were less likely ever to have been tested for HIV. The district-level disparities in HTS uptake may be attributed to differences in the extent of community-based testing and mobile testing services across districts.

The 88.3% HIV testing rate among OVC revealed in this study is lower than the 93% reported for Namibia in 2023 [3]. The lower HIV testing rate among OVC may be linked to barriers to accessing HTS, including financial limitations, insufficient knowledge about HIV, and potential mental health issues stemming from their circumstances [11]. To address barriers to HIV testing, including access and confidentiality, the implementation of innovative strategies such as HIV self-testing and home-based approaches is essential [19,20].

This study revealed that participants 0–9 years of age were more likely to have ever been tested for HIV. This finding contrasts with those of an Eswatini study [21] and a Kenyan study [22], which found an increase in the uptake of HTS with age among young adolescents. The higher likelihood of HIV testing in this age group in the current study may be attributed to caregivers’ concerns regarding potential mother-to-child transmission of the virus [23]. Furthermore, the children may have undergone testing at healthcare facilities during their visits for childhood vaccinations. The study indicated that participants who had been in the program for 0–6 months were more likely to have undergone HIV testing at any point. This can be attributed to services such as health care linkage offered in the OVC program. This study found that individuals who had never enrolled in school were more likely to have undergone HIV testing. An Eswatini study revealed that children with primary education were more likely to be tested for HIV than those with secondary education [21]. We would have expected those who had a higher educational attainment to report more HIV testing since they are taught about HIV in educational institutions.

Participants diagnosed or presumed to have TB were more likely to have undergone HIV testing at some point. This finding can be explained by the practice of healthcare workers providing HIV testing to all individuals diagnosed with or suspected of having TB, due to the established correlation between HIV and TB, along with improved treatment outcomes linked to the concurrent management of both infections [24]. Participants from households with no to moderate hunger were more likely to have ever been tested for HIV. A study conducted among pregnant women in Sub-Saharan Africa reported an association between socioeconomic status and HIV testing [25]. OVC from families with moderate financial means may possess the resources necessary to access HIV testing at healthcare facilities. The economic empowerment of OVC is a crucial strategy for enhancing HIV testing within this demographic. Male participants in this study were less likely to have ever been tested for HIV. This may indicate variations in health-seeking behavior between males and females [26].

Based on the findings of this study, we recommend the implementation of innovative strategies such as HIV self-testing and home-based approaches to overcome barriers to HIV testing and enhance HIV testing coverage among OVC. A Tanzanian study revealed that home-based HIV testing was acceptable to OVC and their caregivers [19]. A South African study revealed that home visits by community healthcare workers increased the likelihood of HIV testing among OVC [20]. Strategies to enhance the uptake of HTS among male OVC include providing male-friendly health services and having HTS provided by male providers [27]. District-level disparities in HTS uptake can be reduced by expanding mobile services and improving community-based testing in districts with low uptake [28]. Furthermore, considering that OVC from households with none to moderate hunger were more likely to have ever had an HIV test than those from households with severe hunger, economic empowerment of OVC is essential to enhance access to HTS. Empowerment of OVC and their caregivers can be achieved through training on income-generating projects and supporting self-help groups that empower caregivers to save money and lend it to others [29]. To reduce household hunger, community-based organizations and non-governmental organizations should help provide food and support gardening [29].

Although this study provided relevant information on the rate of HIV testing among OVC, it was unable to determine when they had the tests. A longitudinal study involving HIV-negative participants should be conducted to assess the changes in HIV testing throughout similar programs. Considering that the program was implemented among high-risk OVC, the findings cannot be generalized to the general OVC population in Namibia. However, since many high-risk OVC were enrolled in similar programs in other regions of the country during the time the PHN program was being implemented, the findings of this study can be generalized to all high-risk OVC in the country. The HIV testing rates among OVC not enrolled in the program might have been lower than those in the program since those in the program were assessed for HIV risk and linked to HTS. Additionally, a significant number of participants had missing data on questions about sexual abuse, exploitation, and sexual debut, reducing the reliability of the findings regarding their influence on HIV testing. The use of verbal confirmation of an HIV test as proof that OVC had ever been tested for HIV may have introduced social desirability bias, since some participants might have confirmed that they were tested for HIV without actually being tested. Some of the information regarding minors was obtained from guardians and caregivers, who might have withheld some information for fear of stigma related to sexual abuse. Furthermore, a qualitative study could yield additional insights into the barriers OVCs face in accessing HTS.

5. Conclusions

Since the onset of the HIV epidemic, over 40 million individuals have died from AIDS-related illnesses, leading to nearly 14 million children aged 0–17 losing one or both parents to AIDS by 2022. OVC face an increased risk of HIV acquisition attributable to socioeconomic factors. OVC also encounter difficulties in obtaining HTS. The study findings indicated that 88.3% of participants had undergone HIV testing at some point. Participants with an increased likelihood of having ever tested for HIV included those aged 0–9 years, those who had been in the program for 0–6 months, and those from households experiencing little or moderate hunger. A multi-pronged approach involving all stakeholders is required to increase HIV testing among OVC. Such an approach should include community-based HIV testing, providing male-friendly healthcare services, and reducing household hunger through economically empowering vulnerable households.